Patient-Centered Medicine and Self-Care of Patients with Type 2 Diabetes: A Cross-Sectional Study




Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 2, Family Practice, Patient-Centered Care, Portugal, Self Care


Introduction: Even though the prevalence rate of diabetes in Portugal is one of the highest in Europe, no studies on the association between patient centered medicine, diabetes self-care, and glycemic control have been published. Assuming that patient centered medicine increases adherence to treatment through the improvement of the doctor-patient relationship, the aim of this study was to assess the influence of patient-centered medicine on the self-care of patients with type 2 diabetes patients’ (T2DM) in two Family Health Units in Central Portugal, according to gender and age.
Material and Methods: A cross-sectional study was conducted in two Family Health Units in Central Portugal between the 25th November 2021 and the 15th January 2022. Patients with type 2 diabetes were invited to fill in the Patient-Centered Medicine questionnaire, for patients (PCM-p) (where higher values represent worse results) and the Summary of Diabetes Self-Care Activities Measure (SDSCAM), (where higher values represent better results), while healthcare professionals filled in the epidemiologic variables on pre-defined days.
Results: A sample of 298 patients with type 2 diabetes was studied. Linear regressions for the association between SDSCAM scale factors and PCM-p showed significant associations for general diet (β = -0.07, p < 0.001), specific diet (β = -0.10, p < 0.001), exercise (β = -0.03, p = 0.008), foot care (β = -0.11, p < 0.001) and medication adherence in general (β = -0.06, p = 0.001). Multiple linear regression including the association between glycated hemoglobin (HbA1c) and the SDSCAM scale dimensions showed that specific diet was associated with lower HbA1c levels (β = -0.01, p = 0.007) and blood sugar testing (β = 0.01, p < 0.001) and that a higher score in PCMp was associated with higher HbA1c levels (β = 0.06, p < 0.001). Male patients (β = -6.93, p = 0.007) and older patients (β = -0.42, p = 0.001) were associated with lower scores in the specific diet. The male gender was associated with higher scores in exercise (β = 7.62, p = 0.029), lower scores in foot care (β = -6.06, p = 0.029) and lower scores in medication adherence to injectable medicines/6.2 (β = -0.73, p = 0.018). Age was associated with a lower score in medication (β = -0.03, p = 0.045) and a higher PCMp total score (β = 0.07, p = 0.030).
Conclusion: Patient-centered medicine in type 2 diabetics is associated with better self-care behaviors in patients with type 2 diabetes. Gender and age differences were observed in self-care behaviors and age differences were observed in Patient Centered Medicine.


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Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, de La Torre-Saldaña V, León-García E, Serna-Alvarado J, Orea-Tejeda A, et al. Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: an analysis from real-world evidence. BMC Endocr Disord. 2020;20:130. DOI:

Ausili D, Bulgheroni M, Ballatore P, Specchia C, Ajdini A, Bezze S, et al. Self-care, quality of life and clinical outcomes of type 2 diabetes patients: an observational cross-sectional study. Acta Diabetol. 2017;54:1001-8. DOI:

International Diabetes Federation. IDF Diabetes Atlas 2019. 2019. [cited 2021 Dec 05]. Available from:

Cardoso AF, Queirós P, Amaral AS, Fontes-Ribeiro C, Rosa A, Cruz R, et al. Validation of the therapeutic self-care scale-european Portuguese version in primary care type 2 diabetes adults. Int J Environ Res Public Health. 202222;19:3750. DOI:

Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord. 2013;12:1. DOI:

Paiva D, Abreu L, Azevedo A, Silva S. Patient-centered communication in type 2 diabetes: the facilitating and constraining factors in clinical encounters. Health Serv Res. 2019;54:623–35. DOI:

Beverly EA, Ganda OP, Ritholz MD, Lee Y, Brooks KM, Lewis-Schroeder NF, et al. Look who’s (not) talking: diabetic patients’ willingness to discuss selfcare with physicians. Diabetes Care. 2012;35:1466–72. DOI:

Rodrigues T. Medicina centrada na pessoa: validação concorrente com capacitação. 2019. [cited 2022 Mar 24]. Available from: http://hdl.handle. net/10316/89638.

Santiago LM, Simões JA, Vale M, de Faria E, Ferreira PL, Rosendo I. Self-awareness of performing patient-centered medicine in general practice / family medicine: development of a measurement scale. Acta Med Port. 2020;33:407–14. DOI:

Williams JS, Walker RJ, Smalls BL, Hill R, Egede LE. Patient-centered care, glycemic control, diabetes self-care, and quality of life in adults with type 2 diabetes. Diabetes Technol Ther. 2016;18:644-9. DOI:

Cardoso P. Revisão do impacto das intervenções e da medicina centrada na pessoa na diabetes mellitus. 2017. [cited 2022 Mar 30]. Available from:

American Diabetes Association. Glycemic targets: standards of medical care in diabetes. Diabetes Care. 2022;42:S61–70. DOI:

Bastos F, Severo M, Lopes C. Propriedades psicométricas da escala de autocuidado com a diabetes traduzida e adaptada). Acta Med Port. 2007;20:11-20.

Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care. Diabetes Care. 2000;23:943–50. DOI:

Coelho BM, Santiago LM. Medicina centrada na pessoa: validação populacional de um instrumento de medida pela pessoa. Rev Port Med Geral Fam. 2022;38:247-56. DOI:

Fredericks S, Lapum J, Schwind J, Beanlands H, Romaniuk D, McCay E. Discussion of patient-centered care in health care organizations. Qual Manag Health Care. 2012;21:127-34. DOI:

Serviço Nacional de Saúde. Diabetes | Factos e Números 2015. 2015. [cited 2022 Mar 30]. Available from:

Devoe JE, Wallace LS, Fryer GE. Patient age influences perceptions about health care communication. Fam Med. 2009;41:126–33.

Gould GS. Patient-centred tobacco management. Drug Alcohol Rev. 2014;33:93–8. DOI:

Amer FA, Mohamed MS, Elbur AI, Abdelaziz SI, Elrayah ZA. Influence of self-efficacy management on adherence to self-care activities and treatment outcome among diabetes mellitus type 2 sudanese patients. Pharm Pract. 2018;16:1–7. DOI:

Prueksaritanond S, Tubtimtes S, Asavanich K, Tiewtranon V. Type 2 diabetic patient-centered care. J Med Assoc Thail. 2004;87:345–52.

Slingerland AS, Herman WH, Redekop WK, Dijkstra RF, Jukema JW, Niessen LW. Stratified patient-centered care in type 2 diabetes: a clusterrandomized, controlled clinical trial of effectiveness and cost-effectiveness. Diabetes Care. 2013;36:3054–61. DOI:

Pinkhasov RM, Wong J, Kashanian J, Lee M, Samadi DB, Pinkhasov MM, et al. Are men shortchanged on health? Perspective on health care utilization and health risk behavior in men and women in the United States. Int J Clin Pract. 2010;64:475–87. DOI:

Cameron KA, Song J, Manheim LM, Dunlop DD. Gender disparities in health and healthcare use among older adults. J Womens Health. 2010;19:1643–50. DOI:

Craft BB, Carroll HA, Lustyk MK. Gender differences in exercise habits and quality of life reports: Assessing the Moderating Effects of Reasons for Exercise. Int J Lib Arts Soc Sci. 2014;2:65–76.

Jaipaul CK, Rosenthal GE. Are older patients more satisfied with hospital care than younger patients? J Gen Intern Med. 2003;18:23–30. DOI:



How to Cite

Sousa S, Pereira AM, Santiago LM. Patient-Centered Medicine and Self-Care of Patients with Type 2 Diabetes: A Cross-Sectional Study. Acta Med Port [Internet]. 2023 Mar. 31 [cited 2024 May 28];37(1):3-9. Available from: